Browsing by Author "Kotsanas, D."

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    Down the drain:carbapenem-resistant bacteria in intensive care unit patients and handwashing sinks
    (Australasian Medical Publishing Co., 2013) Kotsanas, D.; Wijesooriya, W.R.P.L.I.; Korman, T.M.; Gillespie, E.E.; Wright, L.; Snook, K.; Williams, N.; Bell, J.M.; Li, H.Y.; Stuart, R.L.
    OBJECTIVES: Clinical utility of carbapenem antibiotics is under threat because of the emergence of acquired metallo-β-lactamase (MBL) genes. We describe an outbreak in an intensive care unit (ICU) possibly associated with contaminated sinks. DESIGN, SETTING AND PARTICIPANTS: Four clusters of gram-negative bacteria harbouring the MBL gene blaIMP-4 were detected in the ICU at Dandenong Hospital between November 2009 and July 2012. Epidemiological investigations were undertaken in order to identify a common point source. During September 2012, screening using rectal swabs for all ICU patients, and environmental swabs targeting all ICU hand washing sinks and taps were collected. Samples were cultured onto selective carbapenem-resistant Enterobacteriaceae (CRE) agar. Suspected CRE isolates were further characterised using the modified Hodge test and VITEK 2 and confirmed by polymerase chain reaction and sequencing of MBL genes. Clinical and environmental CRE isolates were typed by pulsed-field gel electrophoresis. RESULTS: Ten clinical isolates and one screening isolate of CRE (consisting of Klebsiella pneumoniae [5], Serratia marcescens [4], Enterobacter cloacae [1] and Escherichia coli [1]) were detected with the blaIMP-4 gene over the 30-03 period. S. marcescens was isolated persistently from the grating and drain of eight central sinks. Molecular typing confirmed that clinical and environmental isolates were related. Tap water cultures were negative. Several attempts to clean and decontaminate the sinks using detergents and steam cleaning proved unsuccessful. CONCLUSION: This report highlights the importance of identification of potential environmental reservoirs, such as sinks, for control of outbreaks of environmentally hardy multi-resistant organisms.
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    The silver lining of disposable sporicidal privacy curtains in an intensive care unit
    (Elsevier, 2014) Kotsanas, D.; Wijesooriya, W.R.P.L.I.; Sloane, T.; Stuart, R. L.; Gillespie, E. E.
    BACKGROUND: The environment is a well-known source of health care-acquired infection. Because of the known risk of contamination, patient privacy curtains require frequent changes to decrease the risk of spread from patients to curtain and visa versa. METHODS: Fourteen disposable sporicidal privacy curtains were tested from December 2012 to June 2013 while hanging in a busy intensive care unit. Significant bacterial pathogens were identified and total bacteria enumerated as colony-forming units. Antimicrobial activity of curtain swatches was also tested against a range of bacteria in the laboratory. Measurements were recorded as zone of inhibition and contact inhibition. A cost analysis to replace standard curtains with disposable sporicidal curtains was also undertaken. RESULTS: Cultures grew low numbers of skin and environmental microorganisms with no methicillin-resistant Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, or Clostridium difficile detected. Vancomycin-resistant enterococci were recovered in very low numbers from 2 curtains where vancomycin-resistant enterococci-infected patients had been located. Privacy curtains demonstrated antimicrobial activity against C difficile and 13 additional bacterial pathogens. CONCLUSION:We conclude that disposable sporicidal privacy curtains are cost-effective and best replaced at 6 months in a high-risk area such as an intensive care unit.